The relationship of ventricular drainage to aneurysmal rebleeding

Pare, Laura; Delfino, Ralph; Leblanc, Richard

doi:10.3171/jns.1992.76.3.0422

Cited by 146 publications

(67 citation statements)

References 31 publications

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“…It has been suggested in several studies that unruptured giant and near-giant aneurysms have a higher probability of subsequent rupture than smaller ones, [9,11,30] and some pathological [21] and clinical [13] evidence supports the possibility of a greater risk of rerupture among larger aneurysms. This view is contrary to the findings of Torner, et al, [23] who stated that the size of an aneurysm is not significantly associated with the risk for recurrent hemorrhage.…”

Section: Discussionmentioning

confidence: 97%

Ruptured giant intracranial aneurysms. Part I. A study of rebleeding

Khurana¹,

Piepgras²,

Whisnant³

1998

FOC

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Object The present study was conducted to estimate the frequency and timing of rebleeding after initial subarachnoid hemorrhage (SAH) from ruptured giant aneurysms. Methods The authors reviewed records of 109 patients who suffered an initial SAH from a giant aneurysm and were treated at the Mayo Clinic between 1973 and 1996. They represented 25% of patients with giant intracranial aneurysms seen at this institution during that 23-year period. Seven of the patients were residents of Rochester, Minnesota, and the rest were referred from other institutions. The aneurysms ranged from 25 to 60 mm in diameter, and 74% were located on arteries of the anterior intracranial circulation. The cumulative frequency of rebleeding at 14 days after admission was 18.4%. Cerebrospinal fluid drainage, cerebral angiography, and delayed aneurysm recurrence were implicated in rebleeding in some of the patients. Rebleeding was not precluded by intraaneurysm thrombosis. Among those who suffered recurrent SAH at the Mayo Clinic, 33% died in the hospital. Conclusions Rebleeding from giant aneurysms occurs at a rate comparable to that associated with smaller aneurysms, a finding that should be considered in management strategies.

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Section: Discussionmentioning

confidence: 97%

Ruptured giant intracranial aneurysms. Part I. A study of rebleeding

Khurana¹,

Piepgras²,

Whisnant³

1998

FOC

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“…4,12,20,21,23 Elevated ICP, however, is also thought to play an important role in the arrest of bleeding from ruptured aneurysms. 6,17,18 These competing factors must be balanced when attempting to evaluate quantitatively or control ICP. Although ICP monitoring and CSF drainage are common practice in the management of patients in whom intracranial aneurysms have ruptured, no large scale trials have been designed to evaluate these protocols.…”

Section: Discussionmentioning

confidence: 99%

Intracranial pressure following aneurysmal subarachnoid hemorrhage: monitoring practices and outcome data

Mack

King²,

Ducruet³

et al. 2003

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Object Elevated intracranial pressure (ICP) is an important consequence of aneurysmal subarachnoid hemorrhage (SAH) that often results in decreased cerebral perfusion and secondary clinical decline. No definitive guidelines exist regarding methods and techniques for ICP management following aneurysm rupture. The authors describe monitoring practices and outcome data in 621 patients with aneurysmal SAH admitted to their neurological intensive care unit during an 8-year period (1996–2003). Methods A fiberoptic catheter tip probe or external ventricular drain (EVD) was used to record ICP values. The percentage of monitored patients varied, as expected, according to admission Hunt and Hess grade (p < 0.0001). Intracranial pressure monitoring devices were used in 27 (10%) of 264 Grade I to II patients, 72 (38%) of 189 Grade III patients, and 134 (80%) of 168 Grade IV to V patients. There was a strong propensity to favor transduced ventricular drains over parenchymal fiberoptic bolts, with the former used in 221 (95%) of 233 cases. This tendency was particularly strong in the poor-grade cohort, in which EVDs were placed in 99% of monitored individuals. The rates of cerebrospinal fluid infection in patients in whom ICP probes (0%) and ventricular drains (12%) were placed accorded with those in the literature. Conclusions Following aneurysmal SAH, ICP monitoring prevalence and techniques differ with respect to admission Hunt and Hess grade and are associated with the patient's functional status at discharge.

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“…6 Pare et al reviewed 128 patients with SAH and found that the incidence of rebleeding was higher in those who had ventricular drainage, poor clinical grade and large aneurysm size. 24 It has been postulated that those with radiographically defined hydrocephalus have a higher intracranial pressure and drainage in this group creates a greater increase in pressure across the aneurysm, and may lead to rerupture. Auer, et al 25 noticed a surprising lack of correlation between the extent of SAH and the level of intracranial pressure.…”

Section: Yesmentioning

confidence: 99%

Acute Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

Mehta

Holness

Connolly

et al. 1996

Can. j. neurol. sci.

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Background: Acute hydrocephalus is a potentially treatable cause of early neurological deterioration after aneurysmal subarachnoid hemorrhage ( §AH). Methods: A retrospective study of 105 consecutive cases of aneurysmal SAH was undertaken to determine those factors significantly related to the development of acute hydrocephalus. Acute hydrocephalus was diagnosed when the bicaudate index was greater than the 95 ,h percentile for age on a CT scan within 72 hours of the ictus. Results: Thirty-one percent of the patients developed acute hydrocephalus. Grade of SAH was a significant factor for the development of acute hydrocephalus on univariate analysis as 87% of patients with acute hydrocephalus (29/32) presented with at least grade 3 (Hunt-Hess) SAH (p < 0.05). In addition, posterior circulation aneurysms on univariate analysis were associated with acute hydrocephalus (p < 0.05). Both premorbid hypertension and intraventricular blood (p < 0.05) were predictors for acute hydrocephalus, whereas intracisternal blood, age and sex were not. On multivariate linear regression analysis, factors found to be significantly associated with acute hydrocephalus were premorbid hypertension, intraventricular blood, CSF diversion and definitive shunt procedures. External ventricular drainage was not associated with any instances of rebleeding. Thirty-seven percent (10/27) of patients with acute hydrocephalus who survived were improved by pre-operative external ventricular drainage. Conclusions: Patients with acute hydrocephalus following SAH can be safely treated with external ventricular drainage. Multiple factors can be identified to predict those patients who will develop acute hydrocephalus post aneurysmal rupture. Approximately 30% of those patients with acute hydrocephalus will require definitive shunt placement. Acute hydrocephalus occurred in 31% of aneurysmal SAH patients in this series. RESUME: Hydrocephalic aigue consecutive a une hemorragie sous-arachnoidienne. Introduction: L'hydrocephalie aigue est une cause traitable de deterioration neurologique precoce suite a une hemorragie sous-arachnoidienne (HSA) due a un anevrisme. Methodes: Nous avons procdde a une etude retrospective de 105 cas consecutifs d'HSA anevrismale afin d'identifier les facteurs significativement relies au developpement de l'hydrocephalie aigue. Un diagnostic d'hydrocephalie aigue etait pose quand l'indice bicaudal etait superieur au 95 c percentile pour Page sur le CT scan fail dans les 72 heures de l'ictus. Resultats: Trente-et-un pourcent des patients ont developpe une hydrocephalic aigue. Le grade de l'HSA etait un facteur significatif du developpeinent d'une hydrocephalic aigue a I'analyse bivariee, 87% des patients avec hydrocephalic aigue (29/32) ayant presente une HSA de grade 3 (Hunt-Hess) ou plus au moment de la consultation initiale (p < 0.05). De plus, les an6vrismes impliquant la circulation posterieure etaient associes avec une hydrocephalic aigue (p < 0.05) a I'analyse univariee. Une hypertension premorbide et la presence d...

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The relationship of ventricular drainage to aneurysmal rebleeding

Cited by 146 publications

References 31 publications

Ruptured giant intracranial aneurysms. Part I. A study of rebleeding

Ruptured giant intracranial aneurysms. Part I. A study of rebleeding

Intracranial pressure following aneurysmal subarachnoid hemorrhage: monitoring practices and outcome data

Acute Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

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